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Background: Dietary and nutrient patterns have been linked to health outcomes related to aging. Food intake is influenced by environmental and genetic factors. The aim of the present study was to compare nutrient patterns across two elderly populations sharing a common ancestral cultural background, but living in different environments., Methods: The diet quality, lifestyle and socioeconomic characteristics of participants from the Three-City Study (3C, France, n = 1712) and the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada, n = 1596) were analyzed. Nutrient patterns and their food sources were identified in the two samples using principal component analysis. Diet quality was compared across sample-specific patterns by describing weekly food intake and associations with the Canadian Healthy Eating Index (C-HEI)., Results: Three nutrient patterns were retained in each study: a healthy, a Western and a more traditional pattern. These patterns accounted for 50.1% and 53.5% of the total variance in 3C and NuAge, respectively. Higher education and non-physical occupations over lifetime were associated with healthy patterns in both studies. Other characteristics such as living alone, having a body mass index lower than 25 and being an ex-smoker were associated with the healthy pattern in NuAge. No association between these characteristics and the nutrient patterns was noted in 3C. The healthy and Western patterns from each sample also showed an inverse association with C-HEI., Conclusion: The two healthy patterns showed important similarities: adequate food variety, consumption of healthy foods and associations with common sociodemographic factors. This work highlights that nutrient patterns derived using a posteriori methods may be useful to compare the nutritional quality of the diet of distinct populations.

Background & Aims: Reducing length of stay (LOS) is a priority for hospitals but patients' decline in nutritional status may have a negative impact. The aims of the study were to assess the change in nutritional status during hospitalization and determine if its decline is associated with prolonged LOS., Methods: This is a prospective cohort study conducted in 18 Canadian hospitals. Subjective global assessment (SGA) and weight measurements were performed at admission and discharge. Patient information was collected at admission and extracted from the chart during hospitalization. Association between LOS and changes in SGA or weight loss ≥5% was tested using multivariate Cox PH approach. Results are expressed as hazard ratios (HR) and their 95% CI., Results: 409 patients (53% male) with a LOS >7 days were analyzed. Patients' median (q1,q3) age was 68 years (58,79) and LOS was 11 days (8,17). At admission, 49% of patients were well nourished (SGA A), 37% were moderately malnourished (SGA B) and 14% were severely malnourished (SGA C). From admission to discharge, 34% remained well-nourished, 29% remained malnourished (SGA B or C), 20% deteriorated and 17% improved. Of the 409 patients, 373 had weight measurements at admission and discharge: 92 (25%) had ≥5% weight loss. Multivariate models showed that after adjusting for covariates, decline in nutritional status from SGA A to B/C or SGA B to C (HR: 0.62, CI: (0.44, 0.87); HR: 0.35, CI: (0.20, 0.62) respectively) and weight loss ≥5% (HR: 0.52; CI: 0.40, 0.69) were significantly associated with longer LOS., Conclusion: In-hospital decline in nutritional status as assessed by SGA or weight loss ≥5% is associated with prolonged LOS independently of factors reflecting demographics, living accommodations and disease severity. This suggests a role for nutrition care in reducing LOS., (Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objectives: Given the high prevalence of malnutrition in hospitalized patients, nurses frequently encounter patients with significantly impaired nutrition status. The objective of this study was to determine nurses' attitudes and perceptions regarding the prevalence, detection, and causes of malnutrition in Canadian tertiary care and community hospitals., Materials and Methods: In this descriptive study, a survey that focused on guidelines for nutrition support of hospitalized patients was completed by Canadian nurses working on medical and surgical wards in 11 hospitals participating in the Canadian Malnutrition Task Force study., Results: The survey was completed by 346 of 723 nurses (response rate 48%). Over 50% of nurses underestimated the documented prevalence of malnutrition in hospitalized patients. Nurses considered identification of malnourished patients very relevant (mean 8.4 on a 10-point scale) and would integrate a 3-question nutrition screen into their admission histories (92.5%). Nurses perceived lack of assistance with eating as a significant contributor to hospital malnutrition (17% felt this was a major contributor). While only 39% of nurses reported access to nutrition-related education, 92% were interested in receiving this form of updating., Conclusions: Nurses consider nutrition assessment important and relevant and require access to training to improve their capacity to detect malnutrition in their patients. Nurses are vital to the nutrition care of hospitalized patients and are well positioned to screen for nutrition risk and assist in nutrition management. The role of nurses in nutrition care needs to be linked to hospital policy., (© 2014 American Society for Parenteral and Enteral Nutrition.)

The objective of this study was to assess the relationship between the quality of mastication and dietary intake among community-dwelling older adults (67-84 years). A secondary analysis of data collected upon entry of participants in the NuAge study was effected. Perceived masticatory efficiency (n=1793) was measured using a questionnaire inspired by the Oral Health Impact Profile. Direct assessment of masticatory efficiency was carried out in a subsample (n=94), using a validated clinical test (Swallowing Threshold Test Index, 0-100%). Dietary intake was calculated from three non-consecutive 24h recalls. Mean scores indicate good perceived masticatory efficiency (Men:26.22±0.19/28;Women:25.81±0.21/28), but weak assessed efficiency (Men:60.8% [CI(57.3-64.2)]; Women:61.2% [CI(57.7-64.7)]). Multivariate regression analysis, adjusting for confounding variables (age, sex, schooling, living alone, income, smoking, chronic conditions, functional autonomy), showed that masticatory efficiency (measured or perceived) was not associated with intake of fruits/vegetables, protein, vitamin C or folic acid.

Background & Aim: Guidelines promote dietitian consult (DC) for nutrition support. In Canada, dietitians are involved in the assessment of malnutrition and provide specialized dietary counseling. It is unknown however, what leads to a DC for patients fed orally. This study identifies independent predictors for a DC and determines what is the proportion of malnourished patients seeing a dietitian., Methods: The Canadian Malnutrition Task Force conducted a prospective cohort study in medical and surgical wards of 18 Canadian hospitals. 947 patients who did not receive enteral or parenteral nutrition were analyzed. At admission, subjective global assessment (SGA), body mass index, patient demography were collected. During hospitalization clinical data, including dietary intake and presence of a DC were obtained. Multivariate logistic regression was completed with dietitian consult ≤ 3 days and 4 + days as the outcome variables., Results: The prevalence of malnutrition (SGA B + C) was 45%. Dietitians were consulted for 23% of patients, and of these consults 44% were well nourished (SGA-A), 37% were mildly/moderately malnourished (SGA-B), and 19% were severely malnourished (SGA-C). DC missed 75% of the SGA-B and 60% of SGA-C patients. Predictors of consultation within 3 days of hospitalization were: renal diet (OR 5.75) modified texture diet (OR 5.38), metabolic diagnosis (3.91), ONS use pre-admission (OR 2.33), severe malnutrition (SGA-C, OR 1.88) and age (OR 0.98). Predictors for 4 + days were: dysphagia (OR 11.4), a new medical diagnosis (OR 2.3), severe malnutrition (OR 2.17), constipation (OR 2.16), more than one diagnosis (OR 1.8), antibiotic use (OR 1.6), and male gender (OR 1.6). Consuming < 50% of food in the first week was not a predictor as only 19% of those with low intake had a DC at 4 + days., Conclusions: Overall predictors of DC were appropriate but SGA B and C patients and those eating <50% were missed. Screening at admission with algorithms of care that include referral to the dietitian are needed to improve the process of nutrition care., (Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

This prospective cohort study was conducted in eighteen Canadian hospitals with the aim of examining factors associated with nutritional decline in medical and surgical patients. Nutritional decline was defined based on subjective global assessment (SGA) performed at admission and discharge. Data were collected on demographics, medical information, food intake and patients' satisfaction with nutrition care and meals during hospitalisation; 424 long-stay (≥7 d) patients were included; 38% of them had surgery; 51% were malnourished at admission (SGA B or C); 37% had in-hospital changes in SGA; 19·6% deteriorated (14·6% from SGA A to B/C and 5% from SGA B to C); 17·4% improved (10·6% from SGA B to A, 6·8% from SGA C to B/A); and 63·0 % patients were stable (34·4% were SGA A, 21·3% SGA B, 7·3% SGA C). One SGA C patient had weight loss ≥5%, likely due to fluid loss and was designated as stable. A subset of 364 patients with admission SGA A and B was included in the multiple logistic regression models to determine factors associated with nutritional decline. After controlling for SGA at admission and the presence of a surgical procedure, lower admission BMI, cancer, two or more diagnostic categories, new in-hospital infection, reduced food intake, dissatisfaction with food quality and illness affecting food intake were factors significantly associated with nutritional decline in medical patients. For surgical patients, only male sex was associated with nutritional decline. Factors associated with nutritional decline are different in medical and surgical patients. Identifying these factors may assist nutritional care.

A 36-item Short Diet Questionnaire (SDQ) was developed to assess usual consumption frequencies of foods providing fats, fibre, calcium, vitamin D, in addition to fruits and vegetables. It was pretested among 30 community-dwelling participants from the Québec Longitudinal Study on Nutrition and Successful Aging, "NuAge" (n = 1793, 52.4% women), recruited in three age groups (70 ± 2 years; 75 ± 2 years; 80 ± 2 years). Following revision, the SDQ was administered to 527 NuAge participants (55% female), distributed among the three age groups, both sexes and languages (French, English) prior to the second of three non-consecutive 24 h diet recalls (24HR) and validated relative to the mean of three 24HR. Full data were available for 396 participants. Most SDQ nutrients and fruit and vegetable servings were lower than 24HR estimates (p < 0.05) except calcium, vitamin D, and saturated and trans fats. Spearman correlations between the SDQ and 24HR were modest and significant (p < 0.01), ranging from 0.19 (cholesterol) to 0.45 (fruits and vegetables). Cross-classification into quartiles showed 33% of items were jointly classified into identical quartiles of the distribution, 73% into identical and contiguous quartiles, and only 7% were frankly misclassified. The SDQ is a reasonably accurate, rapid approach for ranking usual frequencies of selected nutrients and foods. Further testing is needed in a broader age range.

Objectives: We compared the social participation of older adults living in metropolitan, urban, and rural areas, and identified associated environmental factors., Methods: From 2004 to 2006, we conducted a cross-sectional study using an age-, gender-, and area-stratified random sample of 1198 adults (aged 67-82 years). We collected data via interviewer-administered questionnaires and derived from Canadian censuses., Results: Social participation did not differ across living areas (P = .09), but after controlling for potential confounding variables, we identified associated area-specific environmental variables. In metropolitan areas, higher social participation was associated with greater proximity to neighborhood resources, having a driver's license, transit use, and better quality social network (R(2) = 0.18). In urban areas, higher social participation was associated with greater proximity to neighborhood resources and having a driver's license (R(2) = 0.11). Finally, in rural areas, higher social participation was associated with greater accessibility to key resources, having a driver's license, children living in the neighborhood, and more years lived in the current dwelling (R(2) = 0.18)., Conclusions: To enhance social participation of older adults, public health interventions need to address different environmental factors according to living areas.

Objectives: Heat vulnerability is increasing owing to climate change, aging and urbanization. This vulnerability may vary geographically. Our study examined the prevalence and distribution of risk and protective factors of heat-related outcomes among older adults across three health regions of Southern Quebec (Canada)., Method: This secondary cross-sectional study used data from the 1st follow-up of the NuAge longitudinal study, a cohort of community-dwelling older adults, aged 68-82 years at baseline, of three health regions: Eastern Townships, Montreal and Laval. Prevalence of factors, identified in Health Canada guidelines, was measured. An Older Adult Heat Vulnerability Index (OAHVI) simultaneously considering medical, social and environmental factors was constructed. The distribution of each factor and OAHVI was examined across the three regions. Results were weighted for age, sex (overall and region-specific analyses) and region (overall analyses)., Results: Ninety percent of participants had ≥1 risk factor, the most prevalent being: cardiovascular medication (50.8%), hypertension (46.7%), living alone (39.2%), cardiovascular disease (36.9%), living in an urban heat island (34.7%) and needing help in activities of daily living (26.5%). Two thirds of participants had ≥1 protective factor, the most prevalent being talking on the phone daily (70.9%). Heat vulnerability varied greatly by region and this variation was mainly attributable to social and environmental rather than medical factors. According to the OAHVI, 87.2% of participants cumulated ≥2 factors (median = 3.0 factors/participant)., Conclusion: Our results support the need for small-scale assessment of heat vulnerability. This study could help stakeholders tackle heat-related illness and develop regionally tailored prevention programs.

Objectives: To determine internal consistency and criterion validity of a questionnaire assessing perception of masticatory efficiency in community-dwelling older adults., Design: Secondary cross-sectional analysis of baseline data from the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge)., Setting: NuAge is a 5-year (2003-08) observational study of 1,793 men and women aged 67 to 84 in good general health at recruitment., Participants: A sample of 1,789 was used to determine internal consistency of the questionnaire. A subsample (n = 94) of the cohort who underwent a clinical test directly measuring masticatory efficiency was used to determine criterion validity of the questionnaire., Measurements: The questionnaire was a subset of the Oral Health Impact Profile containing 7 Likert-scale questions (score 0-28 points). Masticatory efficiency was assessed using a validated clinical test measuring ability to chew a raw carrot (Swallowing Threshold Test Index, score 0-100%). For perceived and measured data, a higher score indicated better masticatory efficiency., Results: Internal consistency of the questionnaire was deemed good (Cronbach alpha = 0.803). Mean scores were generally high (men, 25.3, 95% confidence interval (CI) = 24.7-25.9; women, 24.3, 95% CI = 23.7-25.0), indicating good perceived masticatory efficiency for men and women. Mean performance test scores were low (men, 60.8%, 95% CI = 57.3-64.2; women, 61.2%, 95% CI = 57.7-64.7). No significant relationship between perceived and measured masticatory efficiency was observed (Pearson correlation coefficient = -0.14, P = .22)., Conclusion: Despite good internal consistency of the questionnaire and the recognized validity of the test, people's perception of their masticatory efficiency does not reflect objective efficiency as measured using a clinical test., (© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.)

Background: Nutritional assessment commonly includes multiple nutrition indicators (NIs). To promote efficiency, a minimum set is needed for the diagnosis of malnutrition in the acute care setting., Objective: The objective was to compare the ability of different NIs to predict outcomes of length of hospital stay and readmission to refine the detection of malnutrition in acute care., Design: This was a prospective cohort study of 1022 patients recruited from 18 acute care hospitals (academic and community), from 8 provinces across Canada, between 1 July 2010 and 28 February 2013. Participants were patients aged ≥18 y admitted to medical and surgical wards. NIs measured at admission were subjective global assessment (SGA; SGA A = well nourished, SGA B = mild or moderate malnutrition, and SGA C = severe malnutrition), Nutrition Risk Screening (2002), body weight, midarm and calf circumference, serum albumin, handgrip strength (HGS), and patient-self assessment of food intake. Logistic regression determined the independent effect of NIs on the outcomes of length of hospital stay (<7 d and ≥7 d) and readmission within 30 d after discharge., Results: In total, 733 patients had complete NI data and were available for analysis. After we controlled for age, sex, and diagnosis, only SGA C (OR: 2.19; 95% CI: 1.28, 3.75), HGS (OR: 0.98; 95% CI: 0.96, 0.99 per kg of increase), and reduced food intake during the first week of hospitalization (OR: 1.51; 95% CI: 1.08, 2.11) were independent predictors of length of stay. SGA C (OR: 2.12; 95% CI: 1.24, 3.93) and HGS (OR: 0.96; 95% CI: 0.94, 0.98) but not food intake were independent predictors of 30-d readmission., Conclusions: SGA, HGS, and food intake were independent predictors of outcomes for malnutrition. Because food intake in this study was judged days after admission and HGS has a wide range of normal values, SGA is the single best predictor and should be advocated as the primary measure for diagnosis of malnutrition. This study was registered at clinicaltrials.gov as NCT02351661., (© 2015 American Society for Nutrition.)

Objectives: Since malnutrition is common in Canadian hospitals, physicians frequently encounter patients with significantly impaired nutrition status. The objective of this study was to determine physician attitudes and perceptions regarding the detection and management of malnutrition in Canadian hospitals., Materials and Methods: A survey based on a previously developed questionnaire that focused on guidelines for nutrition support of hospitalized patients was completed by Canadian physicians working on wards in the 18 hospitals participating in the Canadian Malnutrition Task Force study. Data were analyzed descriptively and according to ward (medical vs surgical) and hospital type (academic vs community)., Results: The survey was completed by 428 of the 1220 physicians who were provided with a questionnaire and asked to participate (response rate 35%). While physicians believe that nutrition assessment should be performed at admission (364/419 [87%]), during hospitalization (363/421 [86%]), and at discharge (327/418 [78%]), most felt that this was not being done on a regular basis (admission, 140/423 [33%]; during hospitalization, 175/423 [41%]; at discharge, 121/424 [29%]). Similarly there was a gap between what was perceived to be the ideal management of hospital-related malnutrition and current practices. Physicians felt that the team's nutrition education and use of dietetic resources could be increased, and although their nutrition knowledge was limited, they felt that hospital-associated malnutrition was very relevant to the care they provided., Conclusions: A multidisciplinary team is needed to address hospital malnutrition, and educational strategies that target physicians are needed to promote better detection and management throughout the hospital stay., (© 2014 American Society for Parenteral and Enteral Nutrition.)

Objective: We examined longitudinal associations between weight dissatisfaction, weight changes, anorexia of aging, and obesity among 1,793 seniors followed over 4 years between 2003 and 2009., Method: Obesity prevalence (body mass index [BMI] ≥ 30) and prevalence/incidence of weight dissatisfaction, anorexia of aging (self-reported appetite loss), and weight changes ≥5% were assessed. Predictors of weight loss ≥5%, anorexia of aging, and weight dissatisfaction were examined using logistic regressions., Results: Half of seniors experienced weight dissatisfaction (50.6%, 95% confidence interval [CI] = [48.1, 53.1]). Anorexia of aging and obesity prevalence was 7.0% (95% CI = [5.7, 8.3]) and 25.1% (95% CI = [22.9, 27.3]), whereas incidence of weight gain/loss ≥5% was 6.6% (95% CI = [1.3, 11.9]) and 8.8% (95% CI = [3.3, 14.3]). Weight gain ≥5% predicts men's subsequent weight dissatisfaction (odds ratio [OR] = 6.66, 95% CI = [2.06, 21.60]). No other association was observed., Discussion: Weight dissatisfaction is frequent but not associated with subsequent eating disorders. In men, weight gain predicted weight dissatisfaction. Seniors' weight dissatisfaction does not necessarily equate weight changes. Due to its high prevalence, it is of public health interest to understand how seniors' weight dissatisfaction may impact health., (© The Author(s) 2014.)

Objectives: To identify statistical methods for harmonization, the procedures aimed at achieving the comparability of previously collected data, which could be used in the context of summary data and individual participant data meta-analysis of cognitive measures., Study Design and Setting: Environmental scan methods were used to conduct two reviews to identify (1) studies that quantitatively combined data on cognition and (2) general literature on statistical methods for data harmonization. Search results were rapidly screened to identify articles of relevance., Results: All 33 meta-analyses combining cognition measures either restricted their analyses to a subset of studies using a common measure or combined standardized effect sizes across studies; none reported their harmonization steps before producing summary effects. In the second scan, three general classes of statistical harmonization models were identified (1) standardization methods, (2) latent variable models, and (3) multiple imputation models; few publications compared methods., Conclusion: Although it is an implicit part of conducting a meta-analysis or pooled analysis, the methods used to assess inferential equivalence of complex constructs are rarely reported or discussed. Progress in this area will be supported by guidelines for the conduct and reporting of the data harmonization and integration and by evaluating and developing statistical approaches to harmonization., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Both diet quality (DQ) and physical activity (PA) have been shown to play a role in the prevention of functional capacity (FC) decline. Because older adults (OA) with T2D are at a higher risk of FC decline compared to their non-diabetic counterparts, our aim was to determine if DQ alone, or combined with PA is associated with FC decline in OA with T2D over a 3-year follow-up in a secondary analysis of the NuAge cohort., Methods: In 159 OA with T2D (mean age=75 years), FC change was calculated as the difference in FC scores at T1 and T4 measured by the SMAF (Système de Mesure de l'Autonomie Fonctionnelle). Baseline DQ was calculated from three non-consecutive 24-h dietary recalls collected at T1 using the validated Canadian Healthy Eating Index (C-HEI). PA change was calculated from Physical Activity Scale for the Elderly (PASE) as T4-T1. Associations were evaluated between FC decline and four combinations of variables: C-HEI score < or ≥70 with PASE change < or > median and analyzed by GLM while controlling for covariates., Results: Neither DQ alone nor DQ combined with PA change were associated with FC decline over follow-up., Conclusions: The absence of effect may be explained by characteristics of this healthy sample of OA with T2D who showed relatively good adherence to dietary recommendations (mean C-HEI=70) and were highly functional shown by minimal, clinically non-significant FC decline over 3 years. More research is needed to confirm the role of DQ in preventing FC decline in a larger diabetic sample showing clinically significant FC decline., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Weight loss is prevalent in the elderly population, with deleterious health consequences, notably loss of lean body mass and subsequent functional decline. Protein intake below the current RDA [0.8 g/(kg · d)] is also common in older adults; however, the link between the 2 has received little attention. Our objective was to assess the relation between protein intake and incident 1-y weight loss ≥5% in community-dwelling older adults. We conducted a nested, prospective, case-control study in 1793 community-living elderly participants of the Quebec Longitudinal Study of Nutrition as a Determinant of Successful Aging (NuAge). We studied 211 incident cases of 1-y weight loss (≥5%) and 211 weight-stable controls (±2%) matched by sex and age category (70 ± 2, 75 ± 2, and 80 ± 2 y). Diet was measured by 3 nonconsecutive 24-h recalls. ORs (95% CIs) for the association between protein intake and weight loss were computed by using conditional logistic regression. After adjustment for body mass index, energy intake, appetite, smoking status, physical activity level, physical function, chronic diseases and medications, depressive symptoms, and serum albumin and ultrasensitive C-reactive protein, the ORs of weight loss in participants with low protein intakes [<0.8 g/(kg · d)] were 2.56 (95% CI: 1.01, 6.50) compared with participants with very high protein intakes [≥1.2 g/(kg · d)]. Corresponding numbers were 2.15 (95% CI: 1.02, 4.56) in participants with moderate protein intakes [0.8-<1.0 g/(kg · d)] and 1.33 (95% CI: 0.77, 2.28) in participants with high protein intakes [1.0-1.2 g/(kg · d)]. Our results suggest that protein intakes >1.0 g/(kg · d) are protective against weight loss in healthy older adults. These findings add epidemiologic evidence in support of higher optimal protein intakes than the current guidelines for healthy older adults.

Background: Even with healthy and active aging, many older adults will experience a decrease in physical capacities. This decrease might be associated with diminished functional autonomy. However, little is known about the physical capacities associated with functional autonomy in older women and men., Objective: This study aimed to examine gender-specific associations between functional autonomy and physical capacities in independent older women and men., Methods: Secondary analyses were carried out using cross-sectional data from 652 women and 613 men who participated in the NuAge longitudinal study. The "functional autonomy measurement system" (SMAF) was used to evaluate functional autonomy. The physical capacities measured (tests used) were: biceps and quadriceps strength (Microfet dynamometer), grip strength (Martin vigorimeter), unipodal balance, changing position & walking (timed up and go), normal & fast walking (four-meter walking speed) and changing position (chair stand). Correlation and multiple linear regression analyses adjusted for age, depressive symptoms and body composition were performed., Results: On average, participants were aged 73 years and had mild to moderate functional autonomy loss. In women, after controlling for age, depressive symptoms and body composition, greater functional autonomy was best explained by faster changing position & walking skills and superior biceps strength (R(2)=0.46; p<0.001). After controlling for depressive symptoms, faster changing position & walking skills and better unipodal balance best explained greater functional autonomy in men (R(2)=0.21; p<0.001)., Conclusion: According to these results, physical capacities are moderately associated with functional autonomy among independent older adults, especially women., (Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.)

Diabetic older adults are at a higher risk of muscle strength (MS) decline than their non-diabetic counterparts. Adequate protein and energy intakes and physical activity (PA) may preserve MS during aging. However, the role of diet quality (DQ) in MS maintenance is still unknown. This study aimed to determine the association between DQ - alone or combined with PA - and changes in MS over 3 years in diabetic participants aged 67 to 84 years at recruitment in a secondary analysis of the longitudinal observational NuAge study. Changes in handgrip, knee extensor and elbow flexor strengths were calculated as the difference between recruitment (T1) and after 3 years (T4) in 156 diabetic older adults. Baseline DQ was calculated from 3 non-consecutive 24-hour dietary recalls collected at T1 using the validated Canadian Healthy Eating Index (C-HEI). Change in PA was calculated from Physical Activity Scale for the Elderly (PASE) as PASE T4-PASE T1. Four combinations of variables were created: C-HEI<70 with PASE change either < or > median and C-HEI ≥ 70 with PASE change either < or > median. The association between these four categories and MS maintenance was evaluated using General Linear Modeling (GLM). Analyses were stratified by sex and controlled for covariates. Baseline DQ alone was not associated with MS maintenance. Baseline DQ combined with PASE change showed associations with crude and baseline adjusted handgrip strength (p=0.031, p=0.018) and crude and baseline adjusted elbow flexor change (p=0.028, p=0.017) in males only; no significant results were found for knee extensor strength in either males or females. While findings for females were inconclusive, results demonstrate that better adherence to dietary guidelines combined with a more active lifestyle may prevent MS decline among diabetic older males. Additional research is needed on a larger sample since generalization of these results is limited by the small sample size., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Evidence is accumulating that vitamin K could have a role in cognition, especially in aging. Using data from the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge), a cross-sectional analysis was conducted to examine the associations between vitamin K status, measured as serum phylloquinone concentrations, and performance in verbal and non-verbal episodic memory, executive functions, and speed of processing. The sample included 320 men and women aged 70 to 85 years who were free of cognitive impairment. After adjustment for covariates, higher serum phylloquinone concentration (log-transformed) was associated with better verbal episodic memory performances (F = 2.43, p = 0.048); specifically with the scores (Z-transformed) on the second (β = 0.47; 95% confidence interval [CI] = 0.13-0.82), third (β = 0.41; 95% CI = 0.06-0.75), and 20-minute delayed (β = 0.47; 95% CI = 0.12-0.82) free recall trials of the RL/RI-16 Free and Cued Recall Task. No associations were found with non-verbal episodic memory, executive functions, and speed of processing. Our study adds evidence to the possible role of vitamin K in cognition during aging, specifically in the consolidation of the memory trace., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Cross-sectional studies show that walking is associated with depression among older adults, but longitudinal associations have rarely been examined. The aim of this study was to investigate longitudinal associations between walking frequency and depressive symptoms in older adults to determine which variable is the stronger prospective predictor of the other., Design: Longitudinal; four repeated measures over 5 years., Setting: Population-based sample of urban-dwelling older adults living in the Montreal metropolitan area., Participants: Participants from the VoisiNuAge study aged 68 to 84 (N=498)., Main Exposures: depressive symptoms (Geriatric Depression Scale) and number of walking days in previous week (Physical Activity Scale for the Elderly). Covariates: age, education, and number of chronic illnesses. Cross-lagged panel analyses were performed in the entire sample and in sex-stratified subsamples., Results: Depressive symptoms predicted walking frequency at subsequent time points (and more precisely, higher depressive symptoms were related to fewer walking days), but walking frequency did not predict depressive symptoms at subsequent time points. Stratified analyses revealed that prospective associations were statistically significant in women but not men., Conclusion: The longitudinal association between walking frequency and depressive symptoms is one in which depressive symptoms predict reduced walking frequency later. Higher depressive symptoms are more likely a cause of reduced walking because of time precedence than vice versa. Future research on longitudinal relationships between meeting physical activity recommendations and depression are warranted., (© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.)

Both diet quality and socioeconomic position (SEP) have been linked to age-related cognitive changes, but there is little understanding of how the socioeconomic context of dietary intake may shape its cognitive impact. We examined whether equal adherence to "prudent" and "Western" dietary patterns, identified by principal components analysis, was associated with global cognitive function [Modified Mini-Mental State Examination (3MS)] in independently living older adults with different SEPs (aged 68-84 y; n = 1099). The interaction of dietary pattern adherence with household income, educational attainment, occupational prestige, and a composite indicator of SEP combining all 3 was examined in multiple-adjusted mixed models over 3 y of follow-up in participants of the NuAge study (Quebec Longitudinal Study on Nutrition and Successful Aging). Adherence to the prudent pattern (vegetables, fruits, fish, poultry, and lower-fat dairy products) was related to higher 3MS scores at recruitment only in the upper categories of income [parameter estimate (B): 0.56; 95% CI: 0.11, 1.01], education (B: 0.44; 95% CI: 0.080, 0.80), or composite SEP (B: 0.37; 95% CI: 0.045, 0.70). High prudent pattern adherence was associated with less cognitive decline only in those with low composite SEP (B: 0.25; 95% CI: 0.0094, 0.50). Conversely, adherence to the Western pattern (meats, potatoes, processed foods, and higher-fat dairy products) was associated with more cognitive decline (B: -0.23; 95% CI: -0.43, -0.032) only in those with low educational attainment. In summary, among individuals with equivalent diet quality, the magnitude and characteristics of the diet-cognition relationship depended on their socioeconomic circumstances. These results suggest that interventions promoting retention of cognitive function through improved diet quality would provide maximum benefit to those with relatively low SEP.

It is presently unclear whether there is a significant association between thyroid function and cognitive decline in euthyroid elderly. This case-control study aimed to examine serum thyroid stimulating hormone (TSH), total thyroxine, free thyroxine, total triiodothyronine, and free triiodothyronine in relation to cognitive decline over a 3-year period in a subsample of 62 participants (31 pairs) aged 67 years and over at baseline from the NuAge study (Quebec longitudinal study). They were matched for age, sex and global cognition. In conditional regression logistic models, there was no significant association between any thyroid function indices and the 3-year risk of cognitive decline as measured with the Modified Mini-Mental State Examination (3MS). TSH and thyroid hormones do not appear to be associated with cognitive decline in euthyroid older persons. These findings need confirmation given the small number of pairs of subjects., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Studies of food environment often examine single dimensions of areas that may not account for complexity of exposure to all food sources. With respect to the deprivation amplification hypothesis, particular needs are to assess whether relative or absolute measures of the food environment are related to characteristics of social environment. The objective of this study was to compare absolute availability (AA) of fast food outlets (FFO) and stores selling fresh fruits and vegetables (FVS) with the relative availability (RA) of the same food sources in relation to area-level poverty and ethnic diversity in 248 selected census tracts (CT) in Montreal, Canada. AA of FFO and FVS were expressed as areal densities of food sources within CTs. RA indices were calculated as the proportion of FVSs relative to total food stores and the proportion of FFOs relative to all restaurants within CTs, respectively. Whereas the AA of FFO was positively associated with area-level poverty and ethnic diversity, the RA of FFO was inversely associated with area-level poverty and not associated with ethnic diversity. Both measures of FVS were positively associated with area-level poverty and ethnic diversity. These findings do not support a model of deprivation amplification. Furthermore, results of FFO suggest that the alternate measure of RA can complement information based on AA indicators of the food environment, with potential utility in predicting eating practices.

Objective: This article examined the associations between proximity to selected locations considered to be conducive to social participation, and social participation itself, in urban-dwelling seniors., Methods: A sample of 520 older adults residing in the Montreal area provided reports of social participation and information about health, sociodemographic characteristics, social networks, and perceptions about features of their residential environment. Information about the distance between their home and five locations deemed to be conducive to social participation were obtained from a geographic information system., Results: Analyses showed a significant association between proximity to selected locations and social participation while accounting for individual characteristics and perceptions of neighborhood features (β = 0.37; SE = 0.17; p < 0.05)., Discussion: Findings were consistent with contributions highlighting the impact of the built environment on seniors' health-related behavior. Future work would benefit from the use of longitudinal designs and examinations of social participation through alternate channels.

Lower social participation and less frequent walking represent two factors that may contribute to depression among older adults, but previous research on the subject is inconclusive. The aim of this cross-sectional study was to quantify associations between depression and the combined effects from social participation and walking in a sample of older adults living in Canada (n = 549). Linear and logistic regression analyses were conducted, in which we entered social participation and walking as predictors of depression while controlling for individual characteristics. Results of the final models show that individuals who do not walk outside their home report more depressive symptoms or a greater likelihood of possible clinical depression (the association in our study between social participation and depression was attenuated to non-significance). The current study highlights the central role played by life habits, such as walking, in older adults' mental health status.

Background: There has been little research on the relative importance of frailty markers. The objective was to investigate the association among seven frailty domains (nutrition, physical activity, mobility, strength, energy, cognition, and mood) and their relative contribution in explaining differences among individuals in five samples of older persons., Methods: Data from five studies of aging were analyzed using multiple correspondence analysis. Aggregation of frailty markers was evaluated using graphical output. Decomposition of variability was used to assess the relative contribution of each marker in each sample. Results were combined across the samples to assess the average contribution., Results: Frailty markers were found to consistently aggregate in each sample, suggesting a possible underlying construct. Physical strength had the highest contribution on average in explaining differences among individuals. Mobility and energy also had large contributions. Nutrition and cognition had the smallest contributions., Conclusions: Our results provide further evidence supporting the notion that frailty domains may belong to a common construct. Physical strength may be the most important discriminating characteristic.

Objective: To examine associations between the availability of residential-area food sources and dietary patterns among seniors., Design: Cross-sectional analyses. Individual-level data from the NuAge study on nutrition and healthy ageing were merged with geographic information system data on food store availability and area-level social composition. Two dietary patterns reflecting lower- and higher-quality diets (respectively designated 'western' and 'prudent') were identified from FFQ data. Two food source relative availability measures were calculated for a 500 m road-network buffer around participants' homes: (i) proportion of fast-food outlets (%FFO) relative to all restaurants and (ii) proportion of stores potentially selling healthful foods (%HFS, healthful food stores) relative to all food stores. Associations between dietary patterns and food source exposure were tested in linear regression models accounting for individual (health and sociodemographic) and area-level (socio-economic and ethnicity) covariates., Setting: Montréal metropolitan area, Canada., Subjects: Urban-dwelling older adults (n 751), aged 68 to 84 years., Results: %FFO was inversely associated with prudent diet (β = -0·105; P < 0·05) and this association remained statistically significant in models accounting for %HFS. %HFS was inversely associated with lower western diet scores (β = -0·124; P < 0·01). This latter association no longer reached significance once models were adjusted for area-level covariates., Conclusions: In Montréal, the food environment is related to the diet of older adults but these links are more complex than straightforward. The absence of significant relationships between healthful food stores and prudent diets, and between fast-food outlets and western diets, deserves further investigation.

Despite numerous body image researches focusing on children, adolescents, young and middle-aged adults, there is a dearth regarding the body image of Western seniors. In this paper, we reviewed this literature using a systematic three-step extraction procedure plus a quality evaluation assessment for each retained article. The results showed that, while body dissatisfaction (BD) and body image distortion (BID) exist at older ages, the importance given to body image as it relates to physical appearance is lower in comparison with younger samples. Associations between body image and physical/mental health were also shown. Various tensions regarding the aging body (appearance vs. health, inside vs. outside, natural vs. unnatural) as well as a double standard of aging were also reported among older women. We conclude that the body image experience of Western seniors has both specificities and similarities with the one of younger populations. We also conclude that some methodological aspects of the literature on body image among older adults need to be addressed in order to move forward with this field of research., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Assessment of long-term phylloquinone exposure is challenging in studies investigating vitamin K in health. Data are equivocal as to whether a single measurement of circulating phylloquinone would be adequate. The primary purpose of the present study was to validate the use of a single measurement of serum phylloquinone as a surrogate for long-term phylloquinone exposure in healthy older adults. Using data from the Québec Longitudinal Study on Nutrition and Successful Aging, the objectives were to: 1) determine the reproducibility of circulating phylloquinone over 2 y (n = 234); 2) calculate how a single measurement would rank or classify individuals and attenuate the regression coefficient between circulating phylloquinone and a health outcome; and 3) investigate the association of a single measurement of serum phylloquinone with long-term phylloquinone intakes assessed over the year prior to the blood draw (n = 228). The variance analysis based on 2 blood samples showed a fair to good reproducibility for serum phylloquinone (intra-class correlation = 0.49). The correlation coefficient between the ranking of individuals based on a single measurement of circulating phylloquinone and the "true" ranking would be 0.70. The multiple regression analysis showed that long-term phylloquinone intake was the strongest predictor of serum phylloquinone (t = 4.94; P < 0.001). The partial correlation coefficient (r = 0.32) was comparable with those reported in studies where blood sampling and diet recording were juxtaposed and/or multiple blood samples were used. The present study provides evidence that the use of a single measurement of circulating phylloquinone is adequate for assessing long-term phylloquinone exposure in healthy older adults.

Background and Objectives: A healthy diet may prevent cognitive decline either directly, or by decreasing risk of nutrition-related chronic diseases associated with cognitive decline. This study examined the relationships between diet quality (DQ) and cognition for over 3 years among 1488 older adults (52.6% female) from the NuAge study, aged 67 to 84 years at recruitment., Methods: Cognition was assessed at four annual visits using the modified mini-mental status examination (3MS); rate of cognitive decline was computed for each participant over the 3 years of follow-up using mixed model analyses and the individual-specific number of months between 3MS assessments. Dietary data were collected at recruitment using a validated 78-item, semi-quantitative food frequency questionnaire (FFQ). DQ was characterized as the Canadian Healthy Eating Index (C-HEI), a 9-component global DQ index (maximum score=100) computed from the FFQ output. Other variables were collected by questionnaire or direct measurement. Multivariate analyses were carried out to assess the association of DQ controlled for confounders on cognition., Results: Total C-HEI was better in females (78.7±9.1 vs 75.7±9.4, p<.0001) as were C-HEI component subscores. Males, the less educated, smokers, those with poor social engagement, symptoms of depression, a higher waist:hip ratio and who reported financial insecurity had a poor quality diet that could contribute to chronic diseases associated with cognition. Along with functional autonomy, most of these variables emerged as covariates of baseline 3MS and predictors of cognitive decline. While certain C-HEI subscores and total C-HEI were positive univariate correlates of 3MS at recruitment, total DQ was not associated with cognition in multivariate analyses, either at baseline or over 3 years of follow-up., Conclusions: DQ was not independently associated with cognition. However, the study demonstrates relationships between diet quality and risk factors for chronic diseases associated with cognition. Consequently, older adults might benefit from a healthy diet to decrease risk of nutrition-related chronic diseases established as risk factors for cognitive decline. Further work in diverse older populations, use of dietary data collected earlier in life, finer cognitive measures and longer follow-up are necessary to better elucidate relationships between diet quality, chronic diseases and cognition., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This study examines the association between sodium intake and its interaction with physical activity on cognitive function over 3 years in older adults residing in Québec, Canada. We analyzed a subgroup from the NuAge cohort (aged 67-84 years) with nutrient intake data, including sodium, from a food frequency questionnaire administered at baseline. Baseline physical activity was assessed using the Physical Activity Scale for the Elderly (PASE; high-low). Modified Mini Mental State Examination (3MS) was administered at baseline and annually for 3 additional years. Controlling for age, sex, education, waist circumference, diabetes, and dietary intakes, analyses showed an association between sodium intake and cognitive change over time in the low PASE group only. Specifically, in the low PASE group, elders in the low sodium intake tertile displayed better cognitive performance over time (mean decline in 3MS over years: mean [M] = -0.57, standard error [SE] = 0.002) compared with the highest (M = -1.72, SE = 0.01) and mid sodium intake (M = -2.07, SE = 0.01) groups. This finding may have significant public health implications, emphasizing the importance of addressing multiple lifestyle factors rather than a single domain effect on brain health., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To examine the associations between perceived proximity to neighborhood resources, disability, and social participation and the potential moderating effect of perceived proximity to neighborhood resources on the association between disability and social participation in community-dwelling older women and men., Design: Cross-sectional., Setting: Community., Participants: Older adults (296 women, 258 men)., Interventions: Not applicable., Main Outcome Measures: Data for age, education, depressive symptoms, frequency of participation in community activities, perceived proximity to neighborhood resources (services, amenities), and functional autonomy in daily activities (disability) were collected by means of interviewer-administered questionnaire., Results: Greater perceived proximity to resources and lower level of disability were associated with greater social participation for both women (R(2)=.10; P<.001) and men (R(2)=.05; P<.01). The association between disability and social participation did not vary as a function of perceived proximity to neighborhood resources in women (no moderating effect; P=.15). However, in men, greater perceived proximity to neighborhood resources enhanced social participation (P=.01), but only in those with minor or no disability., Conclusions: Future studies should investigate why perceived proximity to services and amenities is associated with social participation in older men with minor or no disabilities and with women overall, but has no association in men with moderate disabilities., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Decline of physical function with age is associated with substantial health consequences. Physical and psychological functioning is linked, but the temporal nature of this association remains unclear., Methods: Three-year follow-up data from men and women (n = 1,741), aged 68-82 years, in the longitudinal study on nutrition and successful aging (NuAge; Québec, Canada) were used. Growth curve modeling was performed to examine trajectories of a global physical performance score across time as conditioned by cognition and depression., Results: Significant decline in physical function was observed (p < .0001). Rate of decline in physical performance score was accelerated in the older participants (>77 years; age(2): p < .01) but not affected by slight decline in cognition or depression. Yet, people with lower cognition level and more depressive symptoms show lower physical capacity throughout the entire follow-up period (p < .0001)., Conclusions: Physical function significantly declined over 3 years, in particular in the oldest group. A subtle decline in psychological health paralleled decline in physical function but did not accelerate it.

There is a growing interest in the role of vitamin K in health, especially in aging populations. Knowledge of inter- and intra-individual variability of dietary vitamin K intake could be useful to accurately assess usual intake and rank participants in epidemiological studies. Our objectives were to: 1) estimate the variance components of vitamin K intake; 2) investigate whether day of the week, season, and energy intake are factors related to intra-individual variance; and 3) calculate the requisite number of days to achieve desired degrees of accuracy for estimating individual vitamin K intake, ranking individuals and estimating regression coefficient. Vitamin K intake was assessed in 939 older adults (67-84 y) enrolled in the Québec Longitudinal Study on Nutrition and Successful Aging study using 2 sets of 3 nonconsecutive multiple-pass 24-h dietary recalls (24HR) collected 6 mo apart. Each set included 2 weekdays and one weekend day. Intra- to inter-individual variance ratios for vitamin K intake were 3.2 (95% CI = 2.6-3.9) overall, 2.6 (95% CI = 2.1-3.5) for men, and 3.7 (95% CI = 2.9-5.0) for women. Day of the week (weekdays) and season (May to October) were positively and significantly associated with vitamin K intake but explained a negligible part of intra-individual variation (<1%). Adjusting for energy intake explained <7% of variance and did not affect the variance ratio. Six to 13 24HR are required to properly rank individuals according to their usual vitamin K intake and limit attenuation of the regression coefficient. These results should be considered in studies planning to assess vitamin K intakes in older adults.

Objective: To assess the efficacy of a screening tool to be used by nurses to determine which economically disadvantaged pregnant women are most likely to benefit from a dietitian's intensive intervention., Methods: The 26-variable screening tool was used by 53 nurses in 17 Montreal primary care facilities at first contact with 300 subjects who were eligible for prenatal programs for low-income women. Among these, 259 subjects were subsequently interviewed by a Montreal Diet Dispensary (MDD) dietitian using the Higgins Method, established as the gold standard for the detection of a nutritionally at-risk pregnancy. Comparisons of the results obtained by dietitians using the Higgins Method with scores obtained by nurses using the screening tool to determine risk levels and individual variables were analyzed using the Pearson correlation coefficient, receiver operating characteristic (ROC) curves, and predictive indices such as sensitivity, specificity, and predictive values., Results: Because of low agreement between the findings of MDD dietitians and nurses using the screening tool, 10 variables were excluded. The resulting 16-variable tool showed a correlation coefficient of 0.70. The ROC cut-off for this simplified tool was 8, meaning that a woman would be considered at nutritional risk if her score was 8 or more. This score optimized sensitivity (85%) with rather low specificity (50%), but retained a positive predictive value of 87% and a negative predictive value of 55%., Conclusion: Revisions of the screening tool to identify nutritionally at-risk pregnant women led to the development of a simplified screening tool with an acceptable measure of nutritional risk in pregnancy. Hence, the use of this tool by any health professional will identify the majority of the nutritionally at-risk pregnant women most likely to benefit from a dietitian's intensive intervention.

Nutrition screening and early intervention in home-bound older adults are key to preventing unfavourable health outcomes and functional decline. This pilot study's objectives were (a) to test the reliability of the Elderly Nutrition Screening Tool (ENS) when administered by dietician-trained and supervised nutrition volunteers, and (b) to explore the feasibility of volunteers' doing nutrition screening and intervention for home-bound older adults receiving home care services. Both participating clients ( n = 29) and volunteers ( n = 15) were community-dwelling older adults. Volunteers met with participating clients, assessed nutritional risk with the ENS, provided nutritional education, and developed and helped implement intervention plans. To assess ENS (c) inter-rater reliability, we compared results obtained by nutrition volunteers and a dietician. Agreement was high (> or =80%) for most items but was higher among volunteers than between volunteers and the dietician. We conclude that nutrition volunteers can assist in screening and educating older adults regarding nutritional risks, but intervention is best left to professionals.

Objective: To determine the relationship between depressive symptoms and dependence in activities of daily living., Material and Methods: Participants, aged 70 to 104 (n= 1 880), were evaluated twice (2001 and 2003). Depressive symptoms were established by a modified version of Center for Epidemiologic Studies Depression scale, whereas functional dependence was assessed with Lawton & Brody and Katz scales. Dependence implies the attendance and assistance of another person to accomplish the activity. Multivariate regression analyses were used to determine the effect of depressive symptoms on incident dependence., Results: At baseline, 37.9% had depressive symptoms. After two years, 6.1 and 12.7% developed functional dependence for one or more ADL and IADL, respectively. Multivariate analyses showed that depressive symptoms were a risk factor to the development of functional dependence only for the instrumental activities for daily living., Conclusions: Depressive symptoms are a risk factor for functional dependence. Systematic screening it seems necessary in the evaluation of geriatric patients.

Objectives: At any age, good nutrition is important for maintaining good health. Seniors are at risk of declining nutritional status due to the physiological, psychological, economic and social changes that accompany aging. We investigated medical, psychological, social and environmental characteristics as both correlates and predictors of elevated nutritional risk in community-dwelling seniors., Methods: Data came from a prospective study of 839 seniors aged 75 and over, in Montreal. Face-to-face interviews were conducted at baseline and at 12 months. The validated Elderly Nutrition Screening (ENS) tool was administered and subjects were assigned a level of "nutritional risk" based on the risk for energy and nutritional intake deficiencies. Using risk factors identified in the literature, analyses were performed to characterize those factors associated with both the level of risk at baseline and a change in risk over 12 months., Results: At baseline, more than half (60%) of the participants were at elevated nutritional risk. Cross-sectional analyses supported the findings of previous research examining correlates of elevated nutritional risk. Longitudinal results showed that among those at low nutritional risk, only poor self-rated health was found to be a statistically significant predictor of elevated risk at 12 months (OR = 3.30, p < 0.05)., Conclusion: Proper nutrition can promote healthy aging by preventing disease and disability, improving health outcomes and maintaining autonomy, resulting in decreased health care utilization and costs. The findings of this research highlight the need for longitudinal studies in order to better understand and target nutritional risk in community-dwelling seniors.

Objective: To assess the validity of a battery of functional capacity tests in community-living elderly Canadians., Design: cross-sectional study., Study Population: baseline data from 1793 men and women aged 74.4 +/- 4.1 participating in the NuAge longitudinal study were collected from December 2003 to April 2005 and used for the analyses. A global score measuring functional capacities (BFC) was constructed as the sum of four tests according to a method proposed by Guralnik [Timed Up and Go, walking speed (4 m), chair stands (five times), standing balance]. Multivariate linear regression analysis was used to study the relationship between age, sex, and physical activity, and BFC score., Results: The global functional capacities score had an internal consistency of 0.74. It was significantly associated with age, sex and measures of mental and physical health status including: cognitive function (< 0.001), depressive symptoms (< 0.001), nutritional risk (< 0.001), burden of disease (< 0.001), and level of physical activity (< 0.001) thus supporting the construct validity of the global score. Age related differences in BFC were consistent and similar among men and women., Conclusion: The global score of functional capacity tests provided a valid assessment of physical capacities in the community-living elderly. While men had higher global BFC scores than women, among both sexes the best performance was observed in the youngest age group and in those reporting more physical activity.

Background: With the increasing life expectancy and associated health care cost in the elderly population, it is fundamental to study and improve interventions that help older persons to have a better and healthier life in their home for a longer period., Objectives: Evaluate the effect of Meals-on-Wheels (MOW) on dietary intakes of frail elderly., Design: An untreated control group quasi-experimental design with pretest and post-test was used to compare users (n = 20) and non-users (n = 31) of MOW. Descriptive and dietary data were compared at pretest and 8 weeks later. Analysis of Covariance (ANCOVA) was used to control for initial differences between groups., Results: Both groups were similar at pretest except for weight (p = 0.028) and weekly number of meals eaten outside the home (p = 0.008). In both groups, dietary intakes at pretest were below Estimated Average Requirements (EAR) for the same nutrients. At post-test, intake of most nutrients increased in the Experimental group in comparison with the Control group. After controlling with the ANCOVA model, increases were significant for energy (p = 0.050), protein (p = 0.030), lipid (p = 0.034) and thiamin (p = 0.035). Provision of MOW did not permit to achieve a low risk of nutrient inadequacy in the Experimental group., Conclusions: MOW programs improve dietary intakes of recipients. However, a more intensive intervention is needed to prevent nutrient deficiencies in this group.

The aim of this study was to evaluate the antioxidant activity of HDL with aging and to investigate the implication of PON1 in this process. The study involved 54 healthy subjects distributed in two age groups, young (20-25 years) and elderly (65-85 years). Lipid peroxidation was induced by *OH and O2*- oxygen free radicals produced by gamma-radiolysis of water. LDL oxidation was followed by the measurement of conjugated diene (CD), lipid peroxide (LP) and malondialdehyde (MDA) formation. PON1 was purified separately from young (Y-PON1) and elderly subjects (E-PON1). PON1 activity and structure was followed by measurement of PON1 paraoxonase (p.ase) activity, titration of the SH groups, and electrophoretic mobility by SDS-PAGE. Our results show a significant decrease in the HDL antioxidant activity: percentage of protection against CD formation=27.70% (p<0.01) for E-HDL versus 73.08% (p<0.001) for Y-HDL. Moreover, E-PON1 showed a lower antioxidant activity when compared to Y-PON1 47.08% versus 78.14%, respectively (p<0.0001). Exposition of PON1 to *OH and O2*- oxygen free radicals induced a significant decrease in PON1 p.ase activity as well as a reduction in the number of PON1's free sulfhydryl groups. Moreover, our results show a close association between PON1's free sulfhydryl groups and its capacity to protect LDL against lipid peroxidation. There was a significant decrease in the number of free sulfhydryls between Y-PON1 and E-PON1 with respect to cysteine-284 amino acid residues (p<0.0092).

Background: National guidelines for managing diabetes set standards for care. We sought to determine whether a 1-year intensive multitherapy program resulted in greater goal attainment than usual care among patients with poorly controlled type 2 diabetes mellitus., Methods: We identified patients with poorly controlled type 2 diabetes receiving outpatient care in the community or at our hospital. Patients 30-70 years of age with a hemoglobin A1c concentration of 8% or greater were randomly assigned to receive intensive multitherapy (n = 36) or usual care (n = 36)., Results: The average hemoglobin A1c concentration at entry was 9.1% (standard deviation [SD] 1%) in the intensive therapy group and 9.3% (SD 1%) in the usual therapy group. By 12 months, a higher proportion of patients in the intensive therapy group than in the control group had achieved Canadian Diabetes Association (CDA) goals for hemoglobin A(1c) concentrations (goal < or = 7.0%: 35% v. 8%), diastolic blood pressure (goal < 80 mm Hg: 64% v. 37%), low-density lipoprotein cholesterol (LDL-C) levels (goal < 2.5 mmol/L: 53% v. 20%) and triglyceride levels (goal < 1.5 mmol/L: 44% v. 14%). There were no significant differences between the 2 groups in attaining the targets for fasting plasma glucose levels, systolic blood pressure or total cholesterol:high-density lipoprotein cholesterol ratio. None of the patients reached all CDA treatment goals. By 18 months, differences in goal attainment were no longer evident between the 2 groups, except for LDL-C levels. Quality of life, as measured by a specific questionnaire, increased in both groups, with a greater increase in the intensive therapy group (13% [SD 10%] v. 6% [SD 13%], p < 0.003)., Interpretation: Intensive multitherapy for patients with poorly controlled type 2 diabetes is successful in helping patients meet most of the goals set by a national diabetes association. However, 6 months after intensive therapy stopped and patients returned to usual care, the benefits had vanished.

With the aging of the Canadian population, functional autonomy and quality of life among seniors are now important public health issues. We hypothesized that nutrition is an important determinant of the quality of aging because of its potential to modulate the transitions from vulnerability to frailty and dependence. Over the past 15 years, our research program addressed the prevalence, the determinants, and the consequences of undernutrition among seniors, especially the free-living frail elderly. Very low energy and nutrient intakes were observed as well as a high prevalence of involuntary weight loss. These chronic conditions were associated with early institutionalization and increased mortality rates. Intervention strategies were then developed and evaluated, including the Nutrition Screening Program and the Nutrition Support Program. The effectiveness of these programs was shown with respect to improvement of nutritional status. However, this improvement was not sufficient to produce significant changes in functional autonomy or quality of life. Methodological issues related to the conduct of intervention studies in this specific population were addressed. A conceptual framework of nutritional intervention is currently being validated. A large longitudinal study that is being undertaken will further contribute to our understanding of the aging process as determined by a modifiable factor such as nutrition.

Unintentional weight loss, or the involuntary decline in total body weight over time, is common among elderly people who live at home. Weight loss in elderly people can have a deleterious effect on the ability to function and on quality of life and is associated with an increase in mortality over a 12-month period. A variety of physical, psychological and social conditions, along with age-related changes, can lead to weight loss, but there may be no identifiable cause in up to one-quarter of patients. We review the incidence and prevalence of weight loss in elderly patients, its impact on morbidity and mortality, the common causes of unintentional weight loss and a clinical approach to diagnosis. Screening tools to detect malnutrition are highlighted, and nonpharmacologic and pharmacologic strategies to minimize or reverse weight loss in older adults are discussed.

This study compared the changes in some bio-psychosocial variables (functional independence, nutritional risk, pain, balance and walking, grip strength, general well-being, psychiatric profile, perception of social support, leisure satisfaction, and caregivers' feeling of burden) in four categories of clients during their program at a geriatric day hospital (GDH). The study also evaluated whether or not improvements, if any, were maintained 3 months after discharge. One-hundred-and-fifty-one people, categorized by primary reason for admission, were assessed at the GDH with reliable and valid tools, at admission and at discharge. Three months after discharge, they were reassessed with the same tools. Overall, two categories of clients, stroke / neurological diseases and musculoskeletal disorders / amputations, improved the most. For the gait disorders and falls group, only the functional independence score improved, but not at a clinically significant level. Finally, clients in the cognitive function disorders / psychopathologies group improved the most on their well-being scores and caregivers' burden decreased the most. All gains were maintained up to 3 months after discharge, except for leisure satisfaction. With the exception of clients who attended the GDH because of gait disorders and falls, the improvements and maintenance achieved in each category occurred in the domains where improvement had been hoped for, because of the particular disabilities in question and because of the nature of the GDH services offered.

Many "functional foods" (FF), common foods with health benefits beyond their nutritive value, have antioxidant properties with the potential to mediate the degenerative changes of aging. A pilot study was conducted among 51 healthy, home-dwelling elderly people aged 70-86 y (51% male) to develop a method for evaluating relationships between lifelong diet and health. A population-based semiquantitative food frequency questionnaire (FFQ) was used to assess the usual diet. A nonquantitative questionnaire (FF-FFQ) was developed to examine current intake patterns of 33 FF, and at ages 65, 45, 25 and 10 y. Visual and memory cues were employed to help respondents remember past intakes, and their reporting confidence was queried. The instrument was self-administered (among 35%), or administered by a dietitian-interviewer in face-to-face (39%) or telephone (25%) interviews. The FFQ was validated by four dietary recalls statistically adjusted for intraindividual and seasonal variability. The FF-FFQ reliability was assessed in a subsample (n = 20). Mean usual FFQ-derived energy intakes were 7941 +/- 2071 kJ (men) and 7033 +/- 1916 kJ (women). Reported current, regular (several times/mo) FF numbered 18 +/- 4 (men) and 20 +/- 4 (women). These means decreased almost linearly with time; at age 10 y, FF reported were 12 +/- 7 (men) and 15 +/- 4 (women). Men differed from women in their memory of food consumption, food choices and FF intakes. Instrument reliability was good, with 73% identical responses. Food-related memory appears to be linked to dietary knowledge, food preparation experience and availability of foods in the past. The FF-FFQ provides novel data on lifetime FF consumption that may help clarify relationships between diet and health, and the role of diet in aging.

This study validated a measure of pregnancy planning effort based on Miller's conceptual framework in two clinical settings. The questionnaire's main items deal with general behaviour with regard to pregnancy, timing and proception (proception being the reverse of contraception). Values for these three items are added to yield a continuous score ranging from 0 to 12. The study population comprised 448 women of different cultural backgrounds recruited in prenatal, fertility and family planning clinics in Quebec and North Carolina. The results indicate that the internal consistency between the three items pertaining to pregnancy planning was excellent (Cronbach's alpha of 0.83). Test-retest reliability after a 4-week interval was excellent, with an intraclass correlation coefficient of 0.86 for the planning score. The planning score median for women attending family planning clinics (1.00) was significantly lower than that for those recruited in fertility clinics (11.00), confirming the discriminant ability of the instrument. Path analysis shows that the conceptual model corroborates the observed data and explains 53% of the pregnancy planning variability. In conclusion, this is the first questionnaire specifically designed to assess the intensity of pregnancy planning effort, a potentially important variable in epidemiological studies and clinical practice.

Day-to-day variability in dietary intake makes it difficult to measure accurately the "usual" intake of foods and nutrients. The objectives of the present study were to estimate within- and between-subject variability for foods and nutrients by adjusted and unadjusted models and to assess the number of days required to assess nutrient and food group intakes accurately by two different methods. Adult men and women aged 18-65 y (n = 1543) in the Food Habits of Canadians Study provided a 24-h recall. A repeat interview was conducted in a subsample to estimate components of variability. Within- and between-subject variability were determined by mixed model procedure (crude and adjusted for age, gender, education, smoking, family size and season). The number of days required to obtain various degrees of accuracy was ascertained by two methods, one that uses the variance ratio for groups and one that considers within-subject variability alone for individuals. Variance ratios were higher using the adjusted compared with the unadjusted method (e.g., for men, energy 1.07 vs. 0.49). More days were required to reflect usual intake with accuracy using the adjusted model (energy 5 vs. 2 d), indicating the need to control for confounders to obtain reliable estimates of intakes.

Background: Ascorbate and glutathione play central roles in the defense against free radicals and oxidants that are implicated in chronic diseases., Objective: The objective was to determine the ability of vitamin C supplements to modulate the concentration of glutathione in human lymphocytes., Design: The effect of vitamin C supplements was determined in a sequential study with time points before supplementation, after 13 wk of vitamin C supplements (500 or 1000 mg/d), and after 13 wk of matching placebo. The supplementation group was selected on the basis of low plasma ascorbate (<33 mmol/L) and consisted of 48 healthy men and women, smokers and nonsmokers, aged 25-64 y. Ascorbate and glutathione were measured in purified lymphocytes., Results: At baseline, the mean (+/-SD) concentration of plasma ascorbate was 19.5 +/- 7.2 micro mol/L, 22.5 micro mol/L below the median of normal distribution. The ascorbate concentration in plasma was linearly associated with that in lymphocytes (r = 0.53, P < 0.001). On supplementation with vitamin C, lymphocyte ascorbate increased by 51% (from 16.7 +/- 4.9 to 25.3 +/- 6.9 nmol/mg protein; P < 0.001) and was accompanied by an increase of lymphocyte glutathione by 18% (from 22.5 +/- 4.5 to 26.6 +/- 6.5 nmol/mg protein; P < 0.001). After placebo, the ascorbate and glutathione concentrations fell to near baseline concentrations (17.1 +/- 5.4 and 23.5 +/- 6.4 nmol/mg protein, respectively). No significant interaction was observed for sex and smoking status. Finally, the changes in lymphocyte ascorbate after supplementation were strongly associated with changes in lymphocyte glutathione (r = 0.71, P < 0.001). The association suggests that every 1-mol change in ascorbate is accompanied by a change of approximately 0.5 mol in glutathione., Conclusion: Vitamin C supplements increase glutathione in human lymphocytes.